胃肠道癌术后腹腔灌洗液癌胚抗原连续测定的临床意义

Clinical Significance of Successive Determination of Carcinoembryonic Antigen in Peritoneal Washings of Patients after Curative Resection of Gastrointestinal Cancer

目的：研究胃肠道癌根治术后腹腔化疗期腹腔灌洗液癌胚抗原浓度变化动态监测早期腹腔内复发和肝转移的临床意义。方法：对163例胃肠道癌行根治性手术治疗的病人，术后常规行腹腔化疗，采用FDM方案，腹腔灌洗液为20 ml/kg蒸馏水，每次化疗前测定血清癌胚抗原和腹腔灌洗液癌胚抗原的浓度。结果：术后早期腹腔内复发和肝转移血清癌胚抗原检出阳性率为8%，腹腔灌洗液癌胚抗原检出阳性率为96%。腹腔灌洗液CEA＞9.86 ng/ml者高度怀疑有早期腹腔内复发，且多在术后4～5个月发生。腹腔灌洗液CEA＞10.46 ng/ml者高度怀疑为肝转移，多在术后6个月发生。结论：腹腔灌洗液癌胚抗原检测比血清癌胚抗原检测更准确、敏感。

Objective:To study the clinical significance of carcinoembryonic antigen (CEA) in peritoneal washings for hepatic metastasis in patients during chemotherapy after curative resection of gastrointestinal carcinoma.Methods:One hundred and sixty three patients having curative resection of gastrointestinal carcinoma underwent routine chemotherapy according to EDM program.Distilled water (20 ml/kg) was used to irrigate the peritoneal cavity.Before each course of chemotherapy ,the level of CEA in serum and in peritoneal washing were determined separately.Results:In patients with peritoneal recurrence and hepatic metastasis after operation ,the positive rate of CEA in serum was 8% while that in peritoneal was 96%.Peritoneal washing with CEA exceeding 9.86 ng/ml was highly suspected to have early peritoneal recurrence,which could be detected 4～5 months postoperatively,while that exceeding 10.46 ng/ml was highly suspected to have hepatic metastasis and could be detected 6 months postoperatively.Conclusion:The determination of CEA in peritoneal washing is more accurate and more sensitive than that in serum.